HomeMy WebLinkAbout331-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No .~ .~ ......... Date ................ ~?J~l~S~... ~9 .... 19.~.~..
THIS CERTIFIES that the building located at ..Ol~[eo..~c..]4],t~ehJ~!~l~,. ................... Street
Map No .[~t,l~;i,~ .~/a.f,e~'. Block No ....... ~ ........ ,][~,~]Lo.L E,o~t,J'~ol~t .... ,'~..~',
conforms substantially to the Apphcation for Building Permit heretofore filed in th~s office dated
.................. J~r .~.~ ........... 19~. , pursuant to which Bu,ldmg Perm,t No ...~:~..~ ................ ,
dated .................. ~.'-JZte ... ~'. .......... 19...~., was issued, and conforms to all of the requirements
of the applicable provisions of the law The occupancy for which this certificate is issued is ............
................................ PRIVAT.~ DL~-EA. LI~*~G ..........................................................................
This certificate is issued to .~Cl.~...[[~_~., ...(. 'O,~e~'") .......... : ................................................
[owner, lessee or tenant}
of the aforesaid buHd~ng
BuHd,ng inspector
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
/
~'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
!
~'COMPLETION OF THE WORK AUTHORIZED)
N.o , z
P? nission is ,h~reby granted to:
fe:l.a~:e J,-~r..~9..~.~...,L~..q ..... ~.~.e.~...~ ................
/
.......... ~~: .................................
~ ~ ' , ..................................... ~.: ....................................
............................................................................................................
.......... ~ .............. ~ ...... ~ .......................................... , ..........................................................................
ot pre~is es loc~ted'~
t ,....~f n~h~ht. B[~ · 08g$0..1'~ .....................................................
.......... ~ .................... / ........................... ~~.,.~.~r.t..~.~a~g~¢~ ...... ~.,.X., ......................
pucuor~to opphc~t~*n dated .................... ~ .............................. '~W t~...., ond *pproved by the
~n~ [Inspector
Fee
, % Building Inspector
NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
NOTICE OF DISAPPROVAL
FHe No Z 331. .. ............................... ........... Date ..................................................... ,w ........
ao~hh~vem ~.. N.,.Y ....................................
PLEASE TAKE NOTICE that your application dated ........................ .[[.~....~..7. ........... 19..~'..~...
for permit to construct .~..cl..w.e..Z..]=..$.~g ................. at the premises located at ..0..~.s...e..o.....~....}~rf~.g.e...~.~.~
..... B;k~d.~.. ~ozztka.L~,..$T_.~ .................. Street
Mop L. 5~.J:.~ ..W..a..¢.ey.s Block ............ Lot is
]I~l~l~'~z~_~J~m-~L d,sapproved on the following grounds A..g..qA~.e.~..._Z..q..%..~!~.4._~.~..~o ±ent
.... · Bull. Id. lng. · Zone..O~d.i nanc e ..................................................................................................
/s/ Howard M. Terry
Buildm~l Inspector
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FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3. Approval of electrical ~nstallation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building,
5. Submit Planning Board approval of completed site plan requirements where applicable.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty showing all properW lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
Fees:
1. Certificate of occupancy $5.00
2, Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$15.00
New Budding ............. Old or Pre-existing Building .... .x ....... Vacant Land .............
Location of Property .... .O.s.s.e.o...A.~.e.~. ~.e,,..$ .o.~.~.o..~.~.,. ?.¥ .... 1. .~.9.7,1. ......................
House No. Street Hamlet
Frederick W. Geyer, Jr.
Owner or Owners of Property ............................................................
Section 87
County Tax Map No. 1000 Section ...1..09.0 ........ Block .., 3 ........... Lot ..... 19 .........
Subdwision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept, Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .............................
Construction on above described budding and perFmt meets all applicable codes and regulations.
Applicant... :~..~. ~.~...---~--~-.. ................
Rev. 10-10-78
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUT.OLD, N. Y.
Exa mi ned......~J'...~../...~.'.....~.. ...... 19...'~.....e~
0 /
Approved....,.~ .................. 19 ........ Permit No..~
.
........ ..........................
(Buildin~ In~pecIor) ~
Application No ..... ?......~.,.(. .............
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled- in by typewriter or in ink and submitted in duplicate to the Building
Inspector.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagrorn which is part of this location.
c. The work coYered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such
permit shall be kept on the premises available for inspection throughout the progress of the work.
e. N~ building shall be occupied or used in whole or in part for any purpose whatever until o Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or a Iterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
........ ..................
(Sig~bture of applicant, of name, if a corporation)
(Address of apl~cant) ~" ~,
State whether applicant is owner~engineer, general contractor, electrician, plumber or builder.
Name of owner of premises...~~.....~~ .......................................................................................
If applicant is a corporate, signature of duly authorized officer.
(/~ (Nome and title of corl~orote officer)
Location of land on which propasea work w'll b~¢ . p : ........................... :.,~ ......... .~. : ....................
· .
- Municipality
2. State existing use and occupancy of premises an~ intended use and occupancy of proposed construction:
a. Existing use aha occupancy .................................................................................................................................
b. Intended use and occupancy ............................-.- ......................... .~ ......................................................................
3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost....¥...?....~....?. ......................................... Fee ..1.,.~. .................................. ................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ........... ~ ...... Number of dwelling units on each floor..., .......................
If garage, number of O,~,.,,~,-J~ ( C- ~
cars ........
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..............................
7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depth ............................
Height ............................ Number of Stories .............................................................................................................
Dimensions of same structure with alterations or additions: Front ................................ Rear ................................
Depth .............................. Height .............................. Number of Stories ................................
Dimensions of entire new construction: Front ........... .Jl~..~.. ......... Rear .......... ...~..~. .......... Depth ............................
8.
Height ............................ Number of Stories ...~ .........
9. Size of lot: Front .......... X..~'...'~. ........ Rear ........ ~...~...~..:.~ ...... Depth ..~.....~'..Z...I~.. ........
10. Date of Purchase .......... ./...?...~...t~.. ........................ i.....Name of Former Owner ...~......~........~..,~.Z..r~....~.
11. Zone or use district in whch prem ses are s tuated 4~. ~.~.~ ...........................
12. oes proposed construct on v. Lo ate any Ton ng aw, ordnance or reaulation~
/'"J ~ ~/ -A ' ~ ' ......... ~' ........................................
13. Name of Owner of prom ses~.~h-~../,..~.~Address ............................................ Phone NO .....................
Name of Architect ............ [ .......................................... Address ............................................ Phone NO .....................
Name of Contractor..rJ~...'..~..~4~...(~;..~ ~ Address
.................................... Phone NO .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block numbers or description according to deed, and show street names and indicate
'whether interior or corner lot.
STATE OF NEW YCII~K/)/, ) S S
COUNTY OF ..:¢~...~..-~. ~........ ) ~ ~
........................................ ~ ...... .~:...~...being duly sworn, deposes ~nd says that he is the applicant
(Name of individual signing applicat}~3n) . ~ . '
above named. He is the ...................................... ~l~ ~.5 ~ .......................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file
this application; that all statements co.otain~l.i.p this application are true to the best of his knowledge and belief;
and that the work will be performed in~[ti~ ,..~'~,~e~,~:~L~. t~forth in the application f. jled therewith..,
Sworn to before me this :!~ in su~lo'- ~ ~'m ' ~ D /') '~
..... ~....£...~...~.. day of ........... ZlI~I l~:l: ......... ~/~J__,[l:Jl ~ d' (Signature of ,6ppliaant)
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